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General NPI Number Information
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NPI Number | 1417174293
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Entity Type | Organization
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Legal Business Name | FARMACIA SAN ISIDRI ,INC.
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | FARMACIA SAN ISIDRO CARRETERA 188 KILOMETRO 1,6 B-4
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City | CANOVANAS
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State | PR
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Zip | 00729
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Country | US
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Telephone | 787-256-0069
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Fax | 787-256-0069
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Provider Business Mailing Address
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Address Line | FARMACIA SAN ISIDRO CARRETERA 188 KILOMETRO 1,6 B-4
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City | CANOVANAS
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State | PR
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Zip | 00729
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | AILEEN L DEL VALLE
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Credential |
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Telephone | 787-256-0069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 07-F-1579
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License Number State | PR
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